In a chronic allograft is a disorder that occurs in many cases after transplantation of the kidney. The disease is also known as CTN for short and often results in a loss of kidney function in the transplanted organ.
What is Chronic Graft Nephropathy?
Chronic transplant nephropathy occurs comparatively frequently in the context of kidney transplants. In biopsies shows that comprise between 40 and 60 percent of the patients, two years after organ transplantation signs of the disease. The phenomenon occurs in numerous cases even when the transplanted organ is very well accepted by the person’s organism.
Chronic transplant nephropathy is the most important reason for re- dialysis in people who have received a donor organ. In addition, chronic transplant nephropathy is a common cause of permanent renal failure in industrialized countries.
Causes
The causes for the development of chronic transplant nephropathy are very complex and have not yet been conclusively researched. So far, various reasons for the development of the disease are known, which are related to each other. The main causes are immune recognition, inflammatory processes and stress from organic injuries.
The development of the disease takes place in a spectrum between these three factors. So-called calcineurin inhibitors are particularly relevant for the development of chronic transplant nephropathy. These are particularly important for those processes of disease genesis that are not related to immune recognition. Possible influences in this area are, for example, proteinuria and various infections.
The quality of the donor kidney and its age also play an important role. Other contributing factors include increased blood pressure, ischemic lesions of the kidney from the transplant, and cigarette consumption. Chronic graft nephropathy is more common in kidney transplants taken from dead rather than living donors. However, the progression of the disease and its symptoms are almost identical for both origins.
Symptoms, ailments & signs
Chronic transplant nephropathy manifests itself through a number of typical symptoms. As part of the disease, the filter performance of the transplanted kidney decreases continuously. This process of deterioration extends over a period of a few months to several years.
As a result of the decreasing and ultimately failing filtering capacity of the kidney, there is an ultimate and complete loss of kidney function. This kidney failure affects not only the transplanted organ itself, but also the patient’s own two kidneys.
Diagnosis & course
Chronic transplant nephropathy can be diagnosed by various specialists. In the majority of cases, however, the diagnosis of the disease is made by a doctor who was also involved in the kidney transplant or who is responsible for the follow-up control. Chronic transplant nephropathy is often discovered during the regular check-ups that patients with a donor kidney undergo.
Blood tests of the sick people in particular play an important role. The blood is analyzed in the laboratory, with special markers being checked. In the case of chronic transplant nephropathy, there are usually indications of the presence and progression of the disease.
In addition, there are other options for examining and diagnosing chronic transplant nephropathy. As part of a biopsy, tissue is taken from the organ and examined in the laboratory. Doctors find a chronic impairment of the function of the kidneys. Characteristic signs of disease are, for example, pathologically enlarged connective tissue and damage to the bodies and tubules of the organ.
As a result of inflammatory processes, the thickness of the walls of the blood vessels increases. This narrows the so-called lumen. However, the exact cause of the decreasing filter performance of the kidney is often not identifiable in the context of the diagnosis. In addition to chronic transplant nephropathy, rejection of the donor organ caused by the immune system can also trigger the symptoms.
Complications
Graft nephropathy usually results in relatively serious complications because the transplanted kidney does not function properly in the body. Various complaints and complications arise, most of which clearly indicate renal insufficiency. However, the performance of the kidneys can only decline over the years and does not lead to symptoms right at the beginning.
The complete failure of the kidney can lead to death in the worst case without treatment. The affected person is then dependent on dialysis. In most cases, graft nephropathy is treated with medication first. However, no positive course of the disease can be gratinated.
Whether or not kidney function can be maintained also depends heavily on the patient’s physical condition. As a rule, a healthy lifestyle also has a positive effect on transplant nephropathy and can limit or prevent it. Obesity must also be reduced. A causal treatment of transplant nephropathy is unfortunately not possible. If the treatment is unsuccessful, the person concerned is dependent on dialysis. This also reduces life expectancy.
When should you go to the doctor?
In most cases, this complaint occurs while the person is still in the hospital. Because of this, diagnosis and treatment can be initiated immediately. A medical exam will need to be performed if the person’s kidney is not working. The loss of function does not have to occur immediately, but can extend over several months or years. For this reason, the patient depends on regular examinations after the transplant in order to avoid further complications.
Since this can also damage your own kidney, this kidney must also be checked. As a rule, an internist or the doctor treating the kidney transplant can be contacted for this disease. Treatment is then by taking medication. However, the person concerned is still dependent on a donor organ. A psychologist should be consulted in the event of possible psychological complaints or depression. The life expectancy of the person affected may also be significantly reduced as a result of the disease.
Treatment & Therapy
The attending physician prescribes various therapeutic measures to treat the disease. Chronic transplant nephropathy is primarily treated with medication. In addition, the patient is encouraged to change their way of life in a positive way. First, the affected people receive immunosuppressive agents that do not show the effect of calcineurin inhibitors.
This may delay the progression of chronic graft nephropathy. Basically, however, there is currently no specific treatment for chronic transplant nephropathy. Instead, it is the patient’s responsibility to reduce certain risk factors in their own lifestyle.
Obesity should be reduced if possible, and smoking should be given up. The blood pressure is ideally in a low to optimal range. Certain ACE inhibitors sometimes have a beneficial effect on the excretion of proteins. The ingestion of these active substances is prescribed to the patient for the concomitant treatment of chronic transplant nephropathy.
Medical research studies are currently ongoing for the targeted prevention and treatment of chronic transplant nephropathy. Because this also reduces the waiting time of dialysis patients for a donor kidney.
Outlook & forecast
The prognosis of chronic transplant nephropathy must be assessed very individually, but in many cases it is classified as unfavorable. Although the number of affected patients has decreased significantly in the past decades, transplant nephropathy leads to a severe deterioration in the health of the sick or, in the worst case, to the death of the patient.
The prospect of a cure is higher in patients with a donor kidney from a living person than that of a deceased donor. Psychological factors are also important for recovery. The patient’s current experience of stress or possible psychological impairments have a significant influence on the further course of the disease.
If the patient is in emotional equilibrium, their prognosis improves. With a healthy lifestyle and a stable psyche, the existing complaints often decrease. If the patient does not manage to reduce the risk factors, further deterioration usually occurs. In the worst case, the donor kidney can be rejected or an organ failure occurs. This means that the patient is once again exposed to a mortal danger.
Since patients with a donor kidney have had to overcome many challenges in the past, they often lack the optimism necessary to cope with chronic transplant nephropathy when there are complications from the donor kidney.
Prevention
Effective prevention of chronic transplant nephropathy on the part of patients is only possible to a limited extent. A lifestyle that is as healthy as possible makes an important contribution to reducing the risk of chronic transplant nephropathy. Chronic transplant nephropathy is also possible in people who are not overweight or who do not consume tobacco.
Aftercare
Chronic transplant nephropathy occurs as a result of an implanted donor kidney. It causes premature failure of the implanted organ and must be treated immediately. Regular visits to the doctor are therefore essential for patients with implants. No kidney can be transplanted without medical follow-up and constant monitoring.
In the past, the high number of patients in whom a kidney transplant recipient developed chronic transplant nephropathy after only two years was problematic. In up to 60 percent of the implanted patients, this diagnosis was made by means of a biopsy. This usually meant that the patient with kidney disease would need dialysis again.
The complaints required regular medical care so that the donor kidney could be preserved for as long as possible. Everything that is medically done in this sense is part of aftercare. The administered classic immunosuppressants were partly responsible for the development of chronic transplant nephropathy.
The reason is their toxicity, which is particularly damaging to the kidneys. The treating physicians therefore nowadays often prescribe a different immunosuppressant that is less toxic to the kidneys. This has made it possible to reduce the number of people affected with chronic transplant nephropathy.
Since a kidney transplant is a difficult procedure in the body, the follow-up measures must be correspondingly extensive. Otherwise, the transplanted detoxification organ can no longer fulfill its tasks within a few years.
You can do that yourself
Since chronic transplant nephropathy is a side effect of a surgical procedure, the person affected has few options for self-help. Nevertheless, he can influence overall the maintenance of his joie de vivre and quality of life in order to achieve an improvement in his well-being.
The disease is quite common with a kidney transplant. This gives the person affected the opportunity to exchange ideas with other sick people and to use their experiences for themselves. It is always helpful for the healing process to live a healthy lifestyle. This includes a daily routine that is as regulated as possible, good sleep hygiene and a healthy diet. The immune system should be strengthened so that the organism does not become susceptible to pathogens. Obesity should be avoided as well as the consumption of nicotine, alcohol or other drugs. Knowing about your own physical limits helps you to be able to rest in good time.
A stable social environment and participation in social life are also important in promoting the quality of life. Mental health should be promoted with recreational activities, an optimistic outlook on life, and confident thoughts. Mental relaxation techniques can help strengthen the mind and keep you in humor. It helps to address fears openly and, if necessary, to seek therapeutic help.
